Case Report: Fluoxetine-induced leucocytoclastic vasculitis

We report a case of leukocytoclastic vasculitis (LCV) in a 74-year-old woman, occurring seven months after the initiation of fluoxetine therapy for generalized anxiety disorder (GAD). The cutaneous lesions resolved upon discontinuation of fluoxetine but recurred promptly upon rechallenge. Notably, subsequent exposure to paroxetine, another selective serotonin reuptake inhibitor (SSRI) previously tolerated by the patient, also elicited a similar but less severe rash, suggesting cross-sensitization. Transition to venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI), led to complete and sustained resolution of the skin lesions. This case highlights three key clinical points: the potential for delayed-onset cutaneous adverse reactions to SSRIs even after months of uneventful treatment; the occurrence of cross-reactive hypersensitivity among SSRIs; and the importance of considering alternative antidepressant classes with distinct pharmacological profiles in patients with SSRI-associated vasculitis.